Information about cluster headache

Cluster headache is characterised by attacks of severe, unilateral pain. There are approximately 17.000 cluster headache patients in the Netherlands (0.1% of the total population). It affects men more often than women. 

Cluster headache is a very rare disorder, which sometimes causes years of delay in diagnosing a patient. Patients are often misdiagnosed with migraine. This will lead to a non-effective treatment. Correct treatment can  prevent the occurrence of cluster headache attacks or effectively abort an attack. It is therefore very important to recognize this disorder already early in the disease course.

Below you will find a short summary of the symptoms and treatment of cluster headache. 

Symptoms of cluster headache

Cluster headache attacks can vary in clinical presentation. Typically:

  • Attacks occur every other day up to 8 times per day
  • Attacks last between 15 minutes and 3 hours
  • There is severe, unilateral peri-orbital or temporal pain 
  • Attacks are accompanied by one or more of the following symptoms:
    • Red, tearing eye or swollen eye-lid, ipsilateral to the pain
    • Congestion or running nose, ipsilateral to the pain
    • Sweating of forehead/face, ipsilateral to the pain
    • Restlessness/agitation


Cluster headache attacks usually occur in clusters (episodes). Patients experience episodes with frequent attacks lasting weeks to months; with remission periods in between. These episodes often occur during a certain season (e.g. every spring or fall). Approximately 15% of the patients suffer from chronic cluster headache. These patients have attacks every month, week or even day, without remission periods. 

The absence of the characteristic episodes of attacks with remission periods complicates the diagnosis of chronic cluster headache even more so compared to episodic cluster headache. 

Treatment of cluster headache

Treatment of cluster headache consists of both prophylactic (to prevent the occurrence of attacks) and acute treatment (to abort the attack). Options for prophylactic treatment are verapamil and lithium. Options for acute treatment are subcutaneous sumatriptran injections or inhalation of pure oxygen.